@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2015;2(2):1-9

Background
Although pregnancy is a natural funnction for women, it is concidered as a stressful experience which is associated with widespread physical and mental changes in pregnant women [1].
Previous Studies
...[2-9]. Anxiety during pregnancy and childbirth runs a risk of schizophrenia, emotional disorders in the future, autism and asthma in children [10]. Progressive Muscle Relaxation (PMR) method was introduced by Edmund Jacobson in 1934 [3]. … [11-14]. This method is one of the components of behavioral cognitive therapy designed to relieve the tension and stress by Muscle Relaxation [15]… [16-19].
Aim(s)
The aim of current research was to study on consultation effect of Progressive Muscle Relaxation on anxiety (state and trait) among primigravida women.
Research type
This study is a randomized clinical trial on two groups (test and control group) with two stages of pretest and posttest.
Research society, place and time
120 qualified women who had the first pregnancy experience and had referred to the selected health centers in Hamadan were entered the study.
Sampling method and number
Samples were entered the study through convenience sampling. They were divided into intervention and control groups randomly. Criteria of the study entrance were: the age range of 18-35, the first experience of pregnancy and being willable according mother’s statement, singleton pregnancy in 21-22 weeks, the lack of psychiatric disorders according to psychiatrist, not having gestational diabetes, pre-eclampsia, bleeding, premature rupture of membranes, etc., being able to participate in training classes, least ability of reading and writing, lack of hearing and vision problems, not using antidepressants, having mild, moderate or severe anxiety. And study exit criteria included any pregnancy problems during the study (Abruption, abnormal position of the fetus, umbilical cord prolapse, bleeding, diabetes, hypertension, preterm delivery, etc.), abnormal fetal heart rate patterns or fetal movements reduction in a way requiring medical intervention, the lack of willingness to continue cooperating, mental and emotional important changes (such as the death of a loved one or major disputes).
Used devices&materials
There was a primary session to fill in questionnaire of pre-test stage, and members of both groups completed the anxiety questionnaire in 21-22 weeks of gestational age. Control group only received pregnancy usual cares and intervention group, in addition to usual cares, learned how to do progressive muscle relaxation within two 60-minute sessions in two weeks. The instrument used in the study included three parts; first part involved demographic and gynecological information, second part included anxiety evaluation by Spielberger state-trait anxiety inventory and third part was also the daily PMR performance record by pregnant women. Spielberger state-trait anxiety inventory contains 40 questions in which 20 questions measure state anxiety and 20 questions evaluate personality anxiety. It is a multiple choice question. Each 20 items’ scores were added in order to calculate individual’s score. Therefore, each state and trait anxiety’s score was placed in the range between 20 and 80 (0-19 score: natural, 20-40: mild anxiety, 41-60: moderate anxiety and 61- 80: severe anxiety) [5]. According standardization performed by Mahram in Iran, reliability of state anxiety based on Cronbach's alpha is 0.91 and reliability of trait anxiety is 0.90 and the reliability of the total test is 0.94 [20]. The third part of questionnaire included daily PMR performance record’s sheet that had been completed in 70 days by test group. In this study, Gather counseling process was used in a consultation format [21] that performed within two sessions of 45-60 minutes in two weeks. First session included greeting in order to make a verbal relation with pregnant woman, to ask open-ended questions about the subject of the study, to get information about her and then active listening to her responses, required training about the effect of anxiety on gestation and its consequences, muscle relaxation technique and its advantages, as well as video and practical relaxation technique’s training and helping her increasing her knowledge about relaxation techniques in order to select PMR method consciously. Second session consisted of responding to her questions and telling about PMR technique, clarifying her ambiguities and reforming her false beliefs about PMR and also providing more explanations about correct way of PMR. Finally, practical relaxation exercise and training booklet and CD, follow-up periods and weekly calls, asking researchers for help in the case of facing any question were considered. Accuracy of doing exercises was evaluated by trained instructor at the end of these sessions. Intervention group was asked to do these exercises from 21-22 weeks of gestational age at home with the help of training CD and booklet during 10 weeks twice a day (morning and afternoon) each time 20 minutes and complete the daily performance record’s sheet. The group performance was evaluated again through the check list by researcher in 23-24 and 31-32 weeks of gestational age. Researcher had a weekly phone contact with them in order to check and strengthen their performance. Participants of both groups completed anxiety questionnaire again in 31-32 weeks of gestational age as a posttest and then the results were analyzed. Statistical analysis Data was analyzed by SPSS version 20 software. Paired t-test was used to compare the effects of intervention in pre-test and post-test stages and Independent t-test was used to compare the effects of intervention in intervention and control groups. Also, analysis of covariance (ANCOVA) was used in order to control confounding effects in some of the basic variables. It should be noted that it was controlled by randomized method of possible confounding variable. Also pre-test anxiety rate was considered as a possible confounding variable in analysis of covariance. The significance level was determined as 0.05 in all statistical tests.
Findings by Text
120 pregnant women were examined with the mean age of 24.66±4.27and age range of 18-35 years old. 74.1 percent of them had married less than three years and 22.5 percent had married more than three years. Both groups did not have a significant statistical difference and were similar in terms of average age (P=0.635) and time of marriage (year) (P=0.274). There was a most frequent term of education for High school and Diploma group (45%) and the least one for Primary school group (4.2%). Chi-square test results showed that the two groups had an insignificant statistical difference and were similar in terms of education levels and family income (Table1). Independent t-test showed that both test group and control group were similar in the mean score of state and trait anxiety in pre-test stage and there was not a statistically significant difference between two groups in terms of state and trait anxiety levels. In post-test stage in terms of mean and SD of state and trait anxiety, there was a significant increase in control group (P<0.001) and a significant decrease in test group (P<0.001). Table2, the comparison of variables distribution in intervention and control groups, confirms the lack of confounding effects of possible confounding variables (age, education and income). Also, the study results of both groups based on ANCOVA test showed that in post-test stage there was a significant difference between state and trait anxiety score in the two groups (P<0.001).
Main comparison to the similar studies
… [22]. In the study conducted by Rahimi et al., the mean score of state and trait anxiety in women of intervention group was affected by muscle relaxation [23]. In the current study, women’s satisfaction of relaxation technique and their weekly consultation calls can be a factor of better exercise performance and their anxiety reduction. This was also emphasized in the study conducted by Rahimi et al. [23]. … [24-32]
Suggestions
It is suggested that this approach be added in care programs for pregnant women to benefit from its vast advantages.
Limitations
The limitations of current study were small classes and lack of audiovisual facilities in health centers’ training classes, bad conditions effects such as noise in health center and little participation of employed women due to interference of classes with office time.
Conclusions
Overall, it can be concluded that pregnant women’s training for simple PMR technique can influence significantly on reducing the pregnancy anxiety and improving mental health in pregnant women and then next generation’s health.
Acknowledgments
Authors appreciate respectful personnel of health centers in Hamedan city and women participated in the study.
Conflict of interest
Non-declared
Ethical Permissions
The current study was approved by ethic committee of Hamadan University of Medical Sciences and consist of IRCT code (IRCT201412066888N6). All pregnant women assured that their information would be kept absolutely confidential.
Funding Sources
The current study was conducted as M.A. thesis with financial support of Vice Chancellor of Research and Technology of Hamadan University of Medical Sciences .

TABLES and CHARTS

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